Wednesday, June 1, 2016

Early-Life Trauma May Predict Antidepressant Response in Adults With MDD

A report in Translational Psychiatry has found that trauma experienced early in life appears to predict poorer treatment outcomes in adults with depression. According to the authors, the findings suggest that screening for childhood trauma may help to identify patients less likely to benefit from standard first-line antidepressants.

The study, which was part of the international Study to Predict Optimized Treatment for Depression (iSPOT-D), enrolled 1,008 adults with major depressive disorder (MDD) in five countries between 2008 and 2012 and compared them with 336 healthy controls. Participants with depression were randomly assigned to receive one of three treatments: escitalopram, sertraline, or venlafaxine-extended release (XR). All participants answered questions about childhood abuse, family breakup, serious personal health events, and experience of disaster.

Patients with MDD experienced more early-life stress than controls and had at least four times the rate of exposure to childhood sexual, physical, or emotional abuse, wrote Leanne Williams, Ph.D., a professor of psychiatry and behavioral sciences at Stanford University School of Medicine, and colleagues.

The authors found that the experience of abuse, especially if it occurred between the ages of four and seven, significantly predicted poorer outcomes. “[P]articipants were about 1.6 times less likely to achieve response or remission if exposed to abuse at this age,” they wrote.

The researchers also found that abuse occurring from age 4 to 7 years was associated with significantly poorer outcomes following treatment with sertraline compared with those taking escitalopram and venlafaxine-XR—a finding the authors noted may be due to sertraline’s known effect on inhibiting dopamine.

“These results suggest that it is important to assess for childhood trauma in the outpatient management of depression, and to consider alternative or supplemental treatments for patients with a trauma history,” the authors concluded.

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